This Web Page is for summaries of the 2 monthly Concord Dependency Seminars held in Western Sydney between 1999 and 2010. From January 2011 these seminars have transferred to Royal Prince Alfred Hospital and are convened by Dr Richard Hallinan and Prof Paul Haber.

Mrs F complained that people at work disliked her and she contemplated seeking legal advice as she thought they wanted her to leave. She had prolonged disagreements with the pay office about salary and conditions. When she requested a change of appointment with her doctor she “knew” it would be rejected despite it being offered, and complained bitterly about inflexible health professionals” Harari & Meares 2001

Marjorie, a nurse, worked in the night shift in a small hospital. She lived alone with her 6 cats and saw her family only on Christmas Day, an event which she found most anxiety-provoking. Born of elderly parents, she had always been quiet and remote, a compliant child who seemed to need no company. In adult life she found it difficult to understand other people’s need for friends and believed that an emotional life was ‘unnecessary’. Harari & Meares 2001

A Quick Guide to the Personality Disorders (adapted from "DSM Made Easy", an excellent reference tool for the busy clinician!)

"DSM-IV lists 10 personality disorders.... divided into three clusters, A, B, and C........ Five of the 10 have been studied reasonably well and therefore have greater validity than the rest: antisocial, borderline, obsessive-compulsive, schizoid, schizotypal."

Cluster A: "withdrawn, cold, suspicious, or irrational."

Paranoid Personality Disorder:....."distrustful and suspicious of others, whose motives are seen as malevolent."

Schizoid Personality Disorder:..... "isolated from social relationships and shows a restricted emotional range in interpersonal settings."

Schizotypal Personality Disorder:....... "isolation and discomfort with social relationships, as well as perceptual or cognitive distortions and peculiar behaviour."

Cluster B: "dramatic, emotional, and attention-seeking.....moods are labile and often shallow.......often have intense interpersonal conflicts."

Antisocial Personality Disorder:..... "Before age 15, for 12 months or more the patient [satisfied criteria for Conduct Disorder]...repeatedly violated rules, age appropriate societal norms, or the rights of others.... Since age 15, the patient has shown disregard for the rights of others in a variety of situations."

1. A lasting pattern of behaviour and inner experience that markedly deviates from norms of the patient's culture..... evident in at least two of these areas:

• Affect• Cognition• Impulse control• Interpersonal functioning

2. This pattern is fixed and affects many personal and social situations ....[and] causes clinically important distress or impairs work, social, or personal functioning.

3. This pattern has lasted a long time.......with roots in adolescence or young adulthood.

4. It isn't better explained by another mental disorder ......[and] isn't directly caused by a general medical condition or by the use of substances, including medications.

Full Diagnostic Criteria for Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

• Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behaviour covered in criterion 5).

• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and evaluation.

• Identify disturbance: persistent and markedly disturbed, distorted, or unstable self-image or sense of self (eg. feeling like one does not exist or embodies evil).

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

• failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest• deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure• impulsivity or failure to plan ahead• irritability and aggressiveness, as indicated by repeated physical fights or assaults• reckless disregard for safety of self or others• consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations• lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behaviour is not exclusively during the course of Schizophrenia or a Manic Episode.

Disclaimer

On this web site, Dr Byrne and colleagues have written summaries of many research articles, conferences and other events. These have been written largely to draw attention to peer-reviewed studies which may be relevant to clinical practice and public policy. While all care has been taken to be fair and accurate, readers are strongly advised to read the original publications before acting upon the information for clinical decisions.

Due to this brief form of communication, no responsibility can be taken for errors, mistakes or omissions.